You can compare premium costs and benefits for almost all the health
plan options in California here, and can download application forms from
this site.
About health plans in this market:
Individual and family plans are medically underwritten. This means you
can be denied coverage if the carrier thinks you are a medical risk. If
you take medications, have had recent illness, or have a chronic condition,
please contact us BEFORE you apply. Not all
companies view medical conditions in the same way. BCI may be able to
help you select the proper carrier for your condition.
You will be looking at HMO and PPO plan designs. Both types of plans
protect you from financial disaster due to catastrophic medical expenses.
HMO plans typically require you to pay very little for out-patient care.
So, it is easy to budget spending for care IF you need it. In exchange
for the affordable benefits, you have a reduced network of providers,
and must get referred to specialists by your primary care physician. This
restricts your ability to access the most expensive doctors. Think of
HMO plans as "pre-paid" insurance, since you pay little for
care, but have some higher premiums than in some PPO plans.
PPO plans typically require you pay more out of your pocket for medical
care than HMOs WHEN care is delivered. There is usually a deductible each
year to pay first, and then shared costs (coinsurance) up to the annual
maximum out of pocket. The more risk you are willing to take (higher deductibles
and/or out of pocket risk), the lower the premium costs.
In exchange for you helping to share the costs, you get access to a huge
pool of preferred providers, and don’t need a referral to see a
specialist. So, you have a lot more freedom in directing your health care
needs than in an HMO.
PPO plans can be more expensive than HMO plans, but can also be significantly
less expensive.
Since we are all concerned with the cost of health insurance, please
consider the following logic in selecting the proper plan for your health
and your budget.
Most people don’t use their health plan benefits each year, other
than for the occasional trip to the doctor. The likelihood of being hospitalized
in any year is very small. So, how much protection do you really need?
This depends on your style. If you go to the doctor a lot, an HMO may
be best. If you seldom utilize the health system, a less expensive PPO
may fit you better.
The premium you pay each month is the FIRST cost of health care delivery.
You pay the premium whether you use the plan or not. It may be useful
to “annualize” the monthly cost---multiply the monthly premium
by 12---to give you a starting point in your comparison.
There are always some costs in using the health system for care delivery.
The most important benefit is the out of pocket maximum. This is the
“insurance” in any health plan, and defines the maximum
you have to spend on care in any year. ALWAYS compare this number.
Most PPO plans have a deductible to pay before the health plan starts
helping with costs. Also, most health plans have copayments for certain
services. Make sure to note these costs.
Many health plans give well care benefits, office visits, and prescription
drug coverage for flat copay amounts. Always look to see if these benefits
are part of your deductible (if any).
Assess your ability to take on risk. Can you afford to pay a maximum
of $5000 a year in costs IF you get really sick? How about $10,000?
If you can financially handle higher risk, you can dramatically lower
your monthly premium.
Often, premium savings can be used to “finance” your
health care each year. You may be able to save enough in premium to
pay an entire deductible! Or, invest those savings into a Health Savings
Account (HSA)
Make sure the doctors you like are in the network of providers!
